Healthcare Provider Details

I. General information

NPI: 1003688706
Provider Name (Legal Business Name): KAREN CHURCH APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN ROLLOW

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E NIFONG BLVD
COLUMBIA MO
65203-3759
US

IV. Provider business mailing address

5410 DALCROSS DR
COLUMBIA MO
65203-5131
US

V. Phone/Fax

Practice location:
  • Phone: 573-874-6824
  • Fax:
Mailing address:
  • Phone: 214-766-9649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023004936
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: